Left atrial remodelling after septal myectomy is associated with a reduced 5-year risk of atrial fibrillation in hypertrophic cardiomyopathy

Background

Left atrial diameter (LAD) is an established predictor of atrial fibrillation (AF) and adverse outcomes in hypertrophic cardiomyopathy (HCM). However, the impact of LAD remodelling after surgical myectomy on the development of late onset AF is still poorly understood.

Purpose

To investigate the association between LAD remodelling and new occurrence of AF in the first five years after surgical myectomy in a large patient population with HCM.

Methods

1177 HCM patients without a history of AF, subjected to surgical myectomy at two referral centres between 2001 and 2020 were retrospectively reviewed. Paired echocardiographic studies before and shortly after surgical myectomy were available in 894 (76%) patients and 889 (75%) patients had complete LAD measurements, defined as the anteroposterior diameter at end-systole from parasternal long axis view. LAD was considered normal when ≤40mm. Late onset AF was determined as AF documented between one month and 5 years follow up after myectomy. Patients were grouped as having normal LAD pre- and post-myectomy (group 1), enlarged pre-myectomy LAD but normal post-myectomy LAD (group 2), and those with enlarged LAD post-myectomy (group 3). Cox proportional hazards models were applied to evaluate the impact of LAD on late onset AF.

Results

Late onset AF was detected in 63 (7%) patients, 56% male, with an incidence of 1%/year. Patients with AF were older (56±13 vs. 52±14 years, p=0.03), had a larger post-surgery LAD (44±7 vs. 41±6 mm, p<0.001) and a lower left ventricular ejection fraction (58±6 vs. 61±6%, p=0.002) compared to patients without AF. Postoperative left ventricular maximal wall thickness (14±4 mm vs. 15±4mm, p=0.53), left ventricular outflow tract obstruction (6% vs. 8%, p=0.49) or moderate/severe mitral regurgitation (13% vs. 9%, p=0.29) were similar between patients with and without late onset AF. Among the 227 patients in group 1, late onset AF occurred in only 5 (3%), in comparison to 8 (5%) of 182 patients in group 2, and in 36 (10%) of the 480 patients in group 3 (p=0.006). Using group 1 as reference, the hazard ratio for developing AF was 2.1 (95% CI 0.7–6.5, p=0.15) for patients in group 2 and 3.5 (95% CI 1.4–9.4, p=0.005) for patients in group 3.

Conclusion

In our study we were able to show that the overall post-myectomy 5-year risk for developing AF was 1%/year. Normal LAD and reverse LAD remodelling correlated with a lower risk for developing late onset AF, whereas a higher risk was associated with enlarged post-myectomy LAD. These results highlight the possible clinical benefit of LAD remodelling after myectomy in reducing late onset AF.

Funding Acknowledgement

Type of funding sources: None.

Standards for the classification of pathogenicity of somatic variants in cancer (oncogenicity): Joint recommendations of Clinical Genome Resource (ClinGen), Cancer Genomics Consortium (CGC), and Variant Interpretation for Cancer Consortium (VICC)

PURPOSE

Several professional societies have published guidelines for the clinical interpretation of somatic variants, which specifically address diagnostic, prognostic, and therapeutic implications. Although these guidelines for the clinical interpretation of variants include data types that may be used to determine the oncogenicity of a variant (eg, population frequency, functional, and in silico data or somatic frequency), they do not provide a direct, systematic, and comprehensive set of standards and rules to classify the oncogenicity of a somatic variant. This insufficient guidance leads to inconsistent classification of rare somatic variants in cancer, generates variability in their clinical interpretation, and, importantly, affects patient care. Therefore, it is essential to address this unmet need.

METHODS

Clinical Genome Resource (ClinGen) Somatic Cancer Clinical Domain Working Group and ClinGen Germline/Somatic Variant Subcommittee, the Cancer Genomics Consortium, and the Variant Interpretation for Cancer Consortium used a consensus approach to develop a standard operating procedure (SOP) for the classification of oncogenicity of somatic variants.

RESULTS

This comprehensive SOP has been developed to improve consistency in somatic variant classification and has been validated on 94 somatic variants in 10 common cancer-related genes.

CONCLUSION

The comprehensive SOP is now available for classification of oncogenicity of somatic variants.

P079 Effect of sleepwear fibre type on menopausal sleep quality – Study protocol and preliminary data

Introduction

Vasomotor symptoms and sleep disturbances are common in menopausal women. Different fabric types affect thermal comfort through moisture absorption and thermal insulation. This study examined the impact of cotton and wool sleepwear on menopausal women’s sleep quality.

Methods

This is a randomized, crossover, repeated-measures and triple-blinded trial comparing the sleep quality and vasomotor symptoms of healthy menopausal women between cotton and wool sleepwear at 30°C, 50% relative humidity. Participants undergo 6 laboratory visits. After a screening visit and a familiarization night, participants are randomized to 4 nights (2 nights in cotton and 2 nights in wool sleepwear) during which polysomnography and actigraphy recordings are taken including objective hot flush events, room temperature and relative humidity measurements, as well as subjective questionnaires on clothing comfort, mood and vasomotor symptoms.

Results

Eleven participants (age 51.2±4.7 years, BMI 26.8±2.9 kg.m-2, Insomnia Severity Index 11.1±5.5) completed all six visits so far. Reasons for exclusion: 3 didn’t have vasomotor symptoms; 1 on HRT, 5 had severe sleep disturbances, 3 on medications, 4 had diabetes, 1 asthma, and 1 had BMI>30. All sleep-related outcomes are pending analysis (blinding).

Discussion

Recruitment is a major study challenge. Many participants found it hard to arrange a time to attend overnight studies due to family/work commitments. The COVID-19 pandemic changed people’s attitude as some were hesitant to attend the laboratory. Menopause transition status is an important time during women’s lifespan. Effective management, e.g., through appropriate sleepwear, would be helpful to improve menopausal women’s symptom and quality of life.

Trajectories of Alcohol Use and Related Harms for Managed Alcohol Program Participants over 12 Months Compared with Local Controls: A Quasi-Experimental Study

AIM

Investigate changes in alcohol use and related harm using the first multisite, controlled, longitudinal study of Managed Alcohol Programs (MAPs). MAPs provide regular doses of alcohol, accommodation, social supports and healthcare to unstably housed people with alcohol dependence.

METHODS

A multisite, quasi-experimental, longitudinal study was conducted in day centres, shelters and residential programs for unstably housed people. There were 59 MAP participants from six Canadian cities and 116 local controls. Self-reported alcohol consumption and harms were assessed at 0-2, 6 and 12 months. Liver function test results were accessed for MAP participants.

RESULTS

Both groups had similar reductions in mean drinks per day (MAP: -8.11; controls: -8.54 controls, P < 0.001) and days drinking per month (MAP: -2.51 days, P < 0.05; control: -4.81 days, P = 0.0001) over 6--12 months. Both reduced non-beverage alcohol consumption. MAP participants reported significantly fewer harms at both 0-2 and 6 months than controls. MAP participants had similar total consumption to controls, but spread out over more days (25.41 versus 19.64 days per month, P = 0.001). After leaving a MAP, participants' liver status deteriorated, with increases in both aspartate transaminase and bilirubin levels. MAP sites with effective policies on outside drinking drank less and had fewer harms.

CONCLUSION

MAP participants drank less hazardously than controls, especially with effective management of non-MAP drinking. Reductions in alcohol use and harms occurred for both groups, although MAP participants reported fewer harms at 0-6 months. Departing an MAP was associated with deterioration in liver status. Although providing stable housing, MAPs did not worsen health or increase alcohol use.

The Relationship Between Household Food Insufficiency and Development of Type 2 Diabetes over 10 Years in a Sample of U.S. Black and White Adults

Objectives

Household food insufficiency (HFI) is associated with type 2 diabetes (T2D) but longitudinal studies are scarce. Our objectives were to test the relationship of 1) HFI during young-to-middle adulthood with risk of T2D 10 years (y) later; and 2) transient (1 time) or persistent (2 times) HFI with odds of T2D.

Methods

We used data from 3672 black and white adults (32–49y) from Year 15, 20, and 25 follow-up exams of the Coronary Artery Risk Development in Young Adults (CARDIA) Study (2000–2011). Participants with missing HFI or T2D data, prevalent T2D at Year 15 (and Year 20 for objective 2), or reported pregnancy were excluded (n = 720), for a total of n = 2952. At each exam, a screener question captured HFI over the past 12 months. Participants reporting that the food they had to eat was not always what they wanted, sometimes not enough, or often not enough were categorized with HFI. Participants with enough of the kinds of food they wanted were categorized with household food sufficiency. T2D was defined as fasting serum glucose ≥126 mg/dL or hemoglobin A1c ≥6.5%. Multivariable-adjusted repeated-measures and logistic regression models tested the relationships between HFI at Year 15 with risk of T2D at Year 25, and between transient or persistent HFI from Years 15 to 20 with odds of T2D at Year 25, respectively.

Results

T2D prevalence was 4.7% at Year 20 and 9.7% at Year 25. At Year 15, 13.2% reported HFI, and 14.6% and 5.2% were categorized with transient or persistent HFI, respectively. Adjusted for age, sex, and race, HFI at Year 15 was associated with 36% higher risk of T2D by Year 25 (Risk Ratio (95% Confidence Interval (RR (95% CI)): 1.36 (1.02, 1.80); P &lt; 0.05), though the relationship was attenuated after adjustment for education (1.28 (0.96, 1.71)). Compared to no HFI at Years 15 and 20, participants with persistent, but not transient, HFI had higher odds of T2D at Year 25 in fully-adjusted models (Odds Ratio (OR (95% CI)): persistent HFI: 2.06 (1.09, 3.67), P &lt; 0.05; transient HFI: 1.26 (0.76, 2.01)).

Conclusions

Transient or persistent exposure to HFI in young-to-middle adulthood may be a risk factor for developing T2D among black and white adults. Preventing and reducing HFI may be a strategy to reduce socioeconomic and racial disparities in T2D prevalence in the U.S.

Funding Sources

SDSU University Grants Program; NIH NHLBI K01.

P100 Prospective mid-term assessment of frailty in patients implanted with left ventricular assist devices- any reversibility within different domains?

Background

The coalescence of the frailty phenotype and advanced heart failure (HF) presents a unique opportunity to assess any LVAD mediated improvement of cardiac output that may potentially improve the slowness, weakness, fatigue, weight loss and physical inactivity that comprise the frailty phenotype. We sought to determine whether implantation of LVAD could improve frailty in Chinese population.

Methods

From March 2015 to May 2018, 24 patients (pts) with advanced HF underwent LVAD implantation and 16 pts who remained on LVAD support for 18 months were assessed serially every six months. A new multi-disciplinary objective assessment of frailty with relevance to local Chinese population was designed to enable serial reassessment of patient’s clinical progress. The total maximum scores ranged from 0-7 [1. Physical score 0-5 namely exhaustion, poor appetite, weak hand grip, 6 minute hall walk test &lt;400m and reduced physical activity; 2. Cognitive (Montreal Cognitive Assessment-Hong Kong) &lt;22= 1; 3. Depression (Hospital Anxiety and Depression Scale) &gt; = 1].

Results

During the period studied, 5 pts received heart transplantation and 3 pts died. Mean age of remaining 16 pts (94% men) was 53 ± 13 years old. There was significant reduction in total frailty score mainly driven by significant reduction in physical domain. However, frailty was only completely reversible in 8 pts (50%). Improvement in frailty post LVAD were not associated with significant differences in measures of mood or cognition. (Figure 1)

Conclusions

The components of the frailty phenotype in pts with post LVAD surgery all have significant improvements. Absences of any association between improvements in the frailty phenotype and mood or cognition warranted further focused attention in the rehabilitation program for LVAD pts.

Abstract P100 Figure.

P5307A consumer-direct digital health intervention for cardiovascular risk management in primary care: the Consumer Navigation of Electronic Cardiovascular Tools (CONNECT) randomised controlled trial

Background

Digital health interventions linked to electronic health records offer patients an innovative approach to support cardiovascular disease (CVD) risk management.

Purpose

Test the effectiveness of a consumer-directed digital health strategy on medication adherence and cardiovascular health outcomes in patients presenting to primary care who are at moderate to high risk of CVD.

Methods

Randomised controlled trial (RCT) with 12 month follow-up. Intervention group received an interactive digital health strategy for CVD management. The intervention was integrated with patient's electronic health record to enable automated population of risk factor and medication data (Figure). Control group received usual care. Primary outcome was the proportion of patients taking guideline-recommended BP and cholesterol-lowering medications on at least 80% of days (administrative data). Secondary outcomes included mean SBP, LDL-cholesterol, BMI and proportion meeting risk targets for physical activity, achieving smoking cessation, quality of life (EQ5D) and ehealth literacy (eHEALS).

Results

Intervention (n=486) and control (n=448) groups were well matched at baseline (Table). Mean age of participants was 67±8.1 years, 77% were male, 41% had existing CVD. At 12 months, there was no significant difference between the groups for medication days covered or mean cholesterol and BP (Table). However, there were significantly more patients in the intervention than control group who were physically active and had high ehealth literacy (Table).

Table 1. Primary and Secondary Outcomes Baseline 12 months Outcome Control (n=448) Intervention (n=486) Control (n=431) Intervention (n=460) p value* Taking BP and cholesterol medication on ≥80% of days, % 29.7 28.9 29.9 32.8 0.485 SBP (mmHg), mean±SD 139.0±16.6 137.3±15.9 136.3±16.1 136.4±17.6 0.921 LDL (mmol/L), mean±SD 2.6±1.0 2.6±1.0 2.5±0.9 2.4±1.0 0.240 BMI (kg/m2), mean±SD 29.7±5.1 29.9±5.7 29.4±5.0 29.7±5.7 0.508 Proportion achieving BP and LDL target, % 11.2 12.3 11.7 16.5 0.065 Physically active, % 84.0 85.4 79.7 87.0 0.016 Current smoker, % 12.9 13.0 12.0 8.1 0.087 eHEALS, mean±SD 27.0±6.4 27.0±6.4 26.4±7.5 28.3±6.3 0.002 *Comparing intervention and control at 12 month follow-up.

Conclusions

The integrated digital health strategy did not significantly impact on days of medication covered however, patients in the intervention had higher physical activity and ehealth literacy. The RCT highlights the importance of conducting robust research if we are to understand the potential value of digital health interventions.

Acknowledgement/Funding

This work was supported by a Project Grant from the National Health and Medical Research Council of Australia